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Older adults and balance dysfunction

Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
Neurologic Clinics (Impact Factor: 1.61). 09/2005; 23(3):785-805, vii. DOI: 10.1016/j.ncl.2005.01.009
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    • "Shorter steps and longer double support times were associated with smaller sensorimotor regions within the motor, visuospatial, and cognitive speed domains. These findings suggest that measures of gait in older adults living in the community are not only the consequence of underlying age-related changes in peripheral systems (i.e., neuropathology) [49], but that they also indicate underlying focal, selective changes in brain structure [48]. In summary, older adults show larger postural sway, slower gait velocity, and increased stride-to-stride variability under single and particularly multi-task conditions compared to young adults. "
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    ABSTRACT: A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.
    Journal of aging research 01/2012; 2012:708905. DOI:10.1155/2012/708905
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    • "Indeed, Mion et al. (1989) identified impaired proprioception as a contributing factor to falls among patients in a rehabilitative setting. Therefore, the focus here will be on the effects of ageing on proprioceptive receptors even though age-related impairments have been proposed at every stage of the postural control system (Marchetti & Whitney, 2005). [For a detailed review on this topic, see Shaffer and Harrison (2007).] "
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    ABSTRACT: The ageing neuromuscular system is affected by structural and functional changes that lead to a general slowing down of neuromuscular performance and an increased risk of falling. As a consequence, the process of ageing results in a reduced ability to develop maximal and explosive force, as well as in deficits in static and dynamic postural control. A decrease in the number and size of type II fibres in particular accounts for the age-related decline in muscle mass (sarcopaenia) and strength performance. Multiple denervation and re-innervation processes of muscle fibres seem to be responsible for the reduced number of muscle fibres. Recently, it has been suggested that it is not the decline in motoneurons that accounts for the loss in number of muscle fibres but the disturbed potential of fibre regeneration and re-innervation. Furthermore, an age-related reduction in the number of satellite cells has also been associated with sarcopaenia. The ability to compensate for platform and gait perturbations deteriorates with ageing as reflected in longer onset latencies and inefficient postural responses. All sites within the somatosensory system are affected by ageing and therefore contribute to postural instability. However, morphological changes of muscle spindles appear primarily to be responsible for the impaired ability to compensate for balance threats in old age. Given these neuromuscular limitations in old age, it is important to apply adequate training interventions that delay or even reverse the onset of these constraints. Strength training has the potential to enhance maximal as well as explosive force production capacity. This is accomplished by neural factors, including an improved recruitment pattern, discharge rate, and synchronization of motor units. Furthermore, an increase in number of satellite cells most likely accounts for training-induced muscle hypertrophy. Recent studies have investigated the impact of balance training in old age on the ability to develop maximal and explosive force. In addition, the effects of balance training on reflex activity during gait perturbations were also examined. Increases in maximal and explosive force production capacity and an improved ability to compensate for gait perturbations were observed. It is evident from the literature that researchers are increasingly studying the effects of more specifically designed training programmes on performance in populations of older adults. Thus, in the near future, strength training could be replaced by high-velocity forms of power training and balance training by perturbation-based training programmes. It is hypothesized that this new approach is more efficient in terms of fall prevention than the traditional approach
    European Journal of Sport Science 11/2008; 8(6-6):325-340. DOI:10.1080/17461390802478066 · 1.31 Impact Factor
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